The cause of Gulf War Illness (GWI) was a mystery that eluded clinicians and researchers for 30 years – but now, we finally have the answer. In May 2022, UT Southwestern researchers demonstrated that GWI is real, that exposure to the chemical agent sarin is to blame, and that a genetic variant explains why 175,000 Gulf War veterans became chronically ill.
Early in the initial air campaign of the 1991 Gulf War, U.S. and Coalition planes bombed massive Iraqi chemical weapons storage sites, releasing fallout that exposed U.S. troops to low-level sarin nerve agent. Sarin is fatal in high levels of exposure and causes long-term neurological impairment at low exposure levels.
Chemicals from the resulting cloud of debris exposed troops kilometers away, causing a quarter of servicemembers to experience a constellation of debilitating symptoms:
- Debilitating fatigue
- Chronic body pain
- Concentration and memory problems
- Depression and anxiety
- Fever and night sweats
- Sexual dysfunction
- Skin rashes
- Sleep disturbances
- Brain cancer
- Lou Gehrig’s disease
At the time, none of the veterans could have guessed that the mysterious condition, dubbed Gulf War Illness (GWI), would span three decades of suffering. Certainly, they couldn’t have predicted that many government officials and medical professionals would suggest their symptoms were psychosomatic or doubt their condition was even real.
Persevering through 30 years of epidemiologic, clinical and laboratory research at UT Southwestern, we have proven that service members who recalled hearing nerve gas alarms –signaling them to put on their safety gear – and who have a weak form of the PON1 gene were nine times more likely to develop GWI. Normally the PON1 gene protects you from low-level nerve gas, but there is a strong form and a weak form of the gene.
Today, the youngest Persian Gulf War veterans are 50 years old. They’re in the prime of their lives, trying to balance careers, families, and managing chronic symptoms of a condition with no specific treatment. Now that we have proven the cause, our next steps are to develop a medical test and an effective treatment for veterans and families who have sacrificed so much.
Beyond a shadow of doubt
In our latest research, we analyzed data from 1,016 randomly selected Gulf War-era veterans with and without GWI who were deployed to the 1991 Gulf War. Participants completed a telephone interview questionnaire which included questions about hearing the nerve gas alarm sirens, how frequently, and whether they experienced GWI symptoms. They also completed genetic testing and 25 complex nerve and brain imaging studies that we had developed over the prior decade at UT Southwestern.
Because gene allocation is random at birth, our study contained a built-in randomized format. None of the servicemembers could have known their gene variant status when deployed to the war – UT Southwestern first began studying the PON1 variant gene, which reduced the body’s protection against sarin nerve gas, nine years after the war.
Even today, GWI research is controversial; we took every precaution to ensure our study was airtight. We accounted for recall bias (misremembering chemical alarms), and we controlled our statistical analyses for confounding variables – even for ones we had not measured, such as underlying health conditions.
In May 2022, the scientific journal Environmental Health Perspectives published the long-awaited findings about GWI: Hearing nerve gas alarms or having the weaker form of the PON1 gene independently increased the risk of GWI somewhat, but participants who had both of these risk factors were nine times more likely to have GWI.
We proved that genetics contributed to the development of GWI in patients with the weaker form of the PON1 gene, and that environmental exposure to sarin was the source of their symptoms. Our research helped get GWI associated with sarin nerve gas recognized as an identified source of exposure under the PACT Act, a law that expands health care for veterans exposed to toxins and burn pits.
Determining an undeniable cause for GWI was important. But after 30 years of research, the biggest challenge is yet to come – creating and distributing an accurate test and an effective treatment for GWI.
Working toward effective treatment
Our team of UT Southwestern researchers is analyzing the results of two studies that suggest GWI causes chronic inflammation in the brain. If that is proven, it would be a game-changing finding – medication may be able to reduce inflammation, potentially relieving GWI symptoms.
In the future, our new studies based on advanced genomics and proteomics may give us a precise blood test to make a medical diagnosis and new medications that will damp down the brain inflammation and relieve the symptoms.
Until we find a new treatment that reverses the disease, however, the current treatment for GWI focuses on managing symptoms. The veterans who have done the best are those who have found a doctor or psychiatrist who is willing to try different medications until they hit on one that works for the most troubling symptoms. While many have found a balance, some remain partially or totally disabled by their symptoms.
Our hope is that these findings will help Gulf War veterans with an accurate diagnostic test and effective treatment.
Connect with the VA
If you have struggled with GWI symptoms since serving in the Gulf War, talk with a VA general doctor or psychiatrist to build a personalized symptom management plan. While there is not yet a cure, getting the proper care can be life-changing.
The VA does not require Gulf War veterans to prove a connection between their symptoms and service to receive disability compensation. Gulf War veterans who served in the Southwest Asia theater during the 1991 Gulf War and have been diagnosed as at least 10% disabled by one of these conditions may be eligible:
- Functional gastrointestinal disorders
- Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)
You also may be eligible if you have undiagnosed illnesses or chronic multi-symptom illness. Contact your local VA medical center or the reach out to VA North Texas Health Care System to discuss your eligibility.
Ask your members of Congress to fund research on your condition. Above all, advocate for yourself and stay on top of the symptoms you can manage. You have sacrificed and suffered with GWI – we will continue our research until we have a diagnostic test and treatment.
To talk with a doctor about GWI, contact your local VA and ask about the new Toxic Exposures program under the PACT Act.